JP2003265420A - Hemodynamometer with arterial pressure pulse wave analyzing function using brachium pressurizing method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a hemodynamometer capable of holding pressure for a fixed time and detecting the pulse wave, to thereby measure the basal blood pressure and test an examination room hypertension in blood pressure measurement in which the blood pressure is determined according to the waveform change of pulse wave using a cuff band. <P>SOLUTION: This hemodynamometer includes a pressurizing means for pressurizing the cuff band and a fluid in the cuff band, a pressure reducing means for reducing the same, a pressure detecting means for detecting the fluid pressure in the cuff band, a pulse wave detecting means for detecting the pulse wave of a cuff band wearing part, a blood pressure determining means for determining the blood pressure value according to the fluid pressure detected by the pressure detecting means and pulse wave detected by the pulse wave detecting means, a cuff pressure hold means for holding the cuff pressure to constant pressure lower than the diastolic pressure determined by the blood pressure determining means by a designated pressure, a basis pulse rate calculating means for calculating the basis pulse rate, a basis blood pressure judge means for calculating the basis blood pressure, and an examination room hypertension judge means. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a sphygmomanometer, and in particular, a cuff band is used to detect the pulse wave by holding the pressure for a certain period of time when measuring the blood pressure based on the change in the waveform of the pulse wave. And a sphygmomanometer capable of measuring basal blood pressure and determining white coat hypertension.

[0002]

2. Description of the Related Art Blood pressure changes during the day, and the blood pressure value is 100,000 or more times (systolic blood pressure, diastolic blood pressure, mean blood pressure).
Exists. Recently, it has been revealed that the basal blood pressure, which is the lowest blood pressure during wave-removing sleep in a day, is strongly associated with organ damage and cardiac hypertrophy.

Conventionally, the basal blood pressure is measured by wearing a blood pressure monitor using a cuff for 24 hours, or measuring the A line on the artery by 2 lines.
A method in which the blood vessel was left for 4 hours and measured with an open blood pressure monitor was used. All of these methods have a high burden on the patient or are highly risky and highly invasive. Also, in the treatment of hypertension, patients with white-coating hypertension, which is pseudo-hypertension in which blood pressure is high due to anxiety and tension when looking at the white coat of the doctor or nurse even when blood pressure is normal when measuring blood pressure in the clinic. Is present in about 30%, and it is known that consideration is necessary in treating hypertension. If this white coat hypertension is suspected, rest it for a while and measure it again in a calm state, or, like measuring the basal blood pressure, wear a 24-hour sphygmomanometer and measure the white coat hypertension. I was conducting an inspection.

[0004]

However, in measuring the basal blood pressure, when wearing a sphygmomanometer using a cuff for 24 hours, it is necessary to carry out daily activities and sleep while carrying the sphygmomanometer. Great sense of restraint 15-3
At the time of measurement every 0 minutes, there is a problem that the patient's burden is very large physically and mentally such that the arm is tightened and the surrounding people are noticed by the sound of pump pressurization. Further, also in terms of blood pressure measurement accuracy, tightening of the upper arm during sleep, a problem that sleep pressure is hampered to prevent sleep, resulting in high blood pressure, and occurrence of artifacts due to walking, working, etc., and tightening of the arm during sleep. However, there is a problem that the generation of body movement due to the noise of the pressurizing pump becomes an artifact, which hinders accurate blood pressure measurement. Further, in the case of a blood pressure monitor using a cuff, the number of measurements is humanely limited to 72 to 96 times a day due to the burden, and the number of measurements is significantly smaller than 100,000. However, there is a problem of poor accuracy. On the other hand, in open blood pressure measurement, there is an advantage that the blood pressure value can be measured 100,000 times a day, but it is necessary to insert the A line into the artery and leave it in place, and there is a risk of arterial damage, infection, and clot, and management is difficult. There was a problem that it could only be done in a well-kept medical institution and could not be used for normal hypertension treatment.

Further, in the usual hypertensive medical care, it is necessary to wait until the patient is calm and to measure the blood pressure again in the confirmation test when the white coat hypertension is suspected, which requires time for medical treatment. In addition, when a blood pressure monitor using a cuff is worn for 24 hours for inspection, the same problem as in the measurement of basal blood pressure occurs.

The present invention has been made in order to solve the above-mentioned problems, and uses a cuff band to hold the pressure for a certain period of time when measuring the blood pressure to determine the blood pressure based on the waveform change of the pulse wave. An object of the present invention is to provide a sphygmomanometer capable of detecting a pulse wave and measuring basal blood pressure and determining white coat hypertension.

[0007]

In order to solve the above-mentioned problems, the blood pressure monitor of the present invention comprises a pressurizing means for pressurizing a cuff band and a fluid in the cuff band, a depressurizing means for depressurizing the cuff band, and a hold at a constant pressure. Pressure hold means, pressure detecting means for detecting the fluid pressure in the cuff band, pulse wave detecting means for detecting the pulse wave of the cuff band attachment site, and fluid pressure and pulse wave detection by the pressure detecting means A blood pressure determining means for determining a blood pressure value based on the pulse wave detected by the means, and a pulse wave when the cuff pressure is held at a constant pressure lower by a predetermined pressure (about 10 mmHg) than the diastolic blood pressure determined by the blood pressure determining means. It is characterized by having a basal pulse rate calculation means for calculating a basal pulse rate from the output from the detection means, a basal blood pressure calculation means for calculating a basal blood pressure, and a white coat hypertension determination means. Here, white coat hypertension means that when a medical worker such as a doctor or a nurse measures the blood pressure of a patient, the blood pressure is measured higher than the normal blood pressure, and the blood pressure value is in the high blood pressure region.

The basal pulse rate calculating means uses the output of the pulse wave interval measuring means, the output of the pulse wave shape parameter measuring means, the output of the upstroke detecting means, and the output of the blood pressure determining means. It is characterized by Further, the basal blood pressure value calculating means, the output of the basal pulse rate calculating means, the output of the waveform shape parameter detecting means, the output of the pulse wave interval measuring means,
The output of the blood pressure determining means and the output of the up stroke time detecting means are used.

Further, the white-coating hypertension determining means compares the output of the basal blood pressure calculating means with a certain prescribed value to test the white-coating high blood pressure. Also, the waveform shape parameter
The data detection means is characterized by detecting the attenuation characteristic from the pulse wave peak to the bottom.

Further, the basal pulse rate calculating means uses a multivariate analysis of pulse wave waveforms detected by the sphygmomanometer of the present invention collected clinically and basal blood pressure data detected by another method to obtain a plurality of constants. It is characterized by including a means for setting. The basal blood pressure value calculating means sets a plurality of constants by multivariate analysis of the pulse wave waveform detected by the sphygmomanometer of the present invention collected clinically and the basal blood pressure data detected by another method. It is characterized by including means.

Further, the pulse wave detecting means when the pressure is held at a constant pressure is provided with a predetermined time during which the pulse wave is not detected after the pressure reduction is stopped and before the pulse wave detection is started. Is characterized by. Also, the time to hold at a constant pressure,
It is characterized by being within a predetermined second (10 seconds). Further, the basal blood pressure value is a basal blood pressure of systolic blood pressure, a basal blood pressure of diastolic blood pressure, and a basal blood pressure of average blood pressure.

In the sphygmomanometer with the arterial pressure / pulse wave analysis function by the brachial pressurization method having such a configuration, the basal blood pressure and the white coat hypertension can be measured at the same time as the normal blood pressure measurement using the cuff, so that it can be performed in a short time. The patient's burden is small, and it is possible to perform an appropriate blood pressure diagnosis.

[0013]

DETAILED DESCRIPTION OF THE INVENTION The present invention will now be described in more detail with reference to the accompanying drawings.

FIG. 1 is a block diagram of a sphygmomanometer with an arterial pressure pulse wave analysis function by the upper arm pressurization method according to the present invention.
1 is a blood cuff (large cuff), 2 is a pulse wave detection cuff (small cuff), 5 is a pressure sensor for detecting the pressure of the ischemic cuff and the pulse signal of the pulse wave detection cuff (pulse wave detection Means) and 6 are pressurizing pumps (pressurizing means) for pressurizing the cuff, which are controlled by the MPU 10. An MPU is an exhaust / constant-speed decompression valve (exhaust / decompression means) for exhausting the air in the cuffs 1 and 2 at a constant speed, a slight speed, and an exhaust stop, and rapidly exhausting it in a fully opened state.
It is controlled to 10.

Reference numeral 4 is a fluid resistance for attenuating the pulse wave detected by the pulse wave detecting cuff. Reference numeral 3 is a first pipe for connecting the pulse wave detecting cuff 2, the fluid resistance 4 and the pressure sensor-5. Reference numeral 8 is a second pipe that connects the cuff 1 for blood flow prevention, the fluid resistance 4, the pressurizing pump 6, and the exhaust / low-speed decompression valve 7. 9
Is a filter that cuts a frequency unnecessary for cuff pressure detection and pulse wave detection from the output of the pressure sensor, and its output is input to the MPU 10. 10 is a display for displaying the measurement start / stop, pressurization / decompression / exhaust / exhaust stop, pressure measurement, pulse wave detection, blood pressure pulse rate measurement, basal blood pressure measurement, lab coat hypertension detection, blood pressure / pulse rate / lab coat hypertension determination result. It is an MPU that performs the function of displaying and controlling on 12. 12 is LCD or L
ED or plasma display. 11 is MPU10
A memory for storing pulse wave data, pressure, blood pressure, and pulse rate detected every 1 to 30 mS by the MPU 10.
(Storage means). Reference numeral 13 is a start switch for starting measurement, and this operation is input to the MPU 10. Reference numeral 14 denotes a stop switch for stopping the measurement, which is used when stopping the device during the measurement. This switch operation is input to the MPU 10. Although not shown, it has a built-in battery for operating the device.

FIG. 2 is an operation flow chart of a sphygmomanometer with an arterial pressure pulse wave analysis function by the upper arm pressurization method. When the start SW 13 is pressed in step ST1, step ST2
In step S, zero setting of the pressure sensor-5 is performed.
At T3, cuff pressure measurement and display on the display 12 are started. In step ST4, the exhaust / constant-speed decompression valve 7 is closed, the pressurizing pump is turned on, and air is supplied to the large and small cuffs.
Is supplied and the site is pressurized by the large cuff. Step S
At T5, it is determined whether the cuff pressure has been increased to a set pressure higher than the systolic blood pressure. When the set pressure is reached, the pressurizing pump 6 is stopped in step ST6, and the exhaust / constant speed exhaust valve 7 is controlled to start depressurizing the cuff pressure at a predetermined speed (3 to 6 mmHg / sec). Pulse wave detection is performed in step ST7. When the pulse wave is detected, for example, the amplitude and the cuff pressure of the pulse wave detected in step ST8 are stored in the memory-11 as a pair. In step ST9, it is detected whether the pulse wave amplitude exceeds the maximum value, and if it does not exceed the maximum value, the process returns to step ST7 and the pulse wave detection is repeated. If the pulse wave amplitude exceeds the maximum value, the process proceeds to step ST10 for determination of insufficient pressurization.

The first pulse wave amplitude value stored in the memory 11 is compared with the value obtained by multiplying the maximum pulse wave amplitude value by 0.5, and when the first pulse wave amplitude is large, it is added. It is determined that the pressure is insufficient, and in step ST32, for example, the set pressure is changed to a pressure higher than the set pressure + predetermined pressure (40 mmHg) and the exhaust / constant speed exhaust valve is closed. It is turned on and repressurized. Step ST10
If the pressurization is not insufficient at step ST11, the systolic blood pressure is detected by the blood pressure determining means detecting a point where the change in the amplitude data is large from the pulse wave amplitude data stored in the memory 11. (SYS) is determined.

Subsequently, the pulse wave is detected in step ST12, and the amplitude and the cuff pressure are stored in the memory 11 in step ST13. Memory at step ST14
The blood pressure determining means searches the data of the pulse wave amplitude from the pulse wave amplitude stored in 11, and the point where the change becomes small is detected to determine the diastolic blood pressure (DIA). Step ST14
If there is no change in the pulse wave amplitude corresponding to the diastolic blood pressure, return to step ST12 and continue pulse wave detection. When diastolic blood pressure is detected in step ST14, step S
At T15, it is confirmed whether or not the cuff pressure has dropped from the diastolic blood pressure to a predetermined pressure (about 10 mmHg). If it is confirmed, the exhaust / constant speed exhaust valve is closed, and the pressure reduction is stopped at step ST16.

In step ST17, the timer is started and the pulse wave measurement is stopped for a predetermined second (about 2 seconds) until the cuff pressure stabilizes. After about 2 seconds have passed in step ST18, the timer is reset in step ST19. In step ST20, pulse wave detection and storage in the memory-11 are started, and in step ST21, a short decompression stop time of 10 seconds or less at which the influence of congestion is small is desirable. In the present embodiment, steps are performed until about 5 seconds elapse. In ST20, pulse wave detection,
Continue to remember. When about 5 seconds (data number n) have elapsed in step ST21, the exhaust / constant speed exhaust valve is fully opened in step ST22 to exhaust the air in the cuff.

The upstroke time U ₀ (n) is calculated in steps ST23 and ST24 which are upstroke detecting means. In step ST23, the ratio m = L of systolic blood pressure and diastolic blood pressure is calculated from the output of the blood pressure determining means.
Calculate OG (Ps / Pd). In step ST24, the upstroke time U ₀ (n) at the time of basal blood pressure is calculated by multivariate analysis based on clinical data, and is expressed as U ₀ (n) = 0.4.
Calculation is carried out by substituting m for 5 * m ^1/2 -0.1.
In step ST25, the basal pulse rate, which is the pulse rate when the basal blood pressure occurs, is calculated by the basal pulse rate calculation means.

FIG. 3 is a flowchart of the basal pulse rate calculating means.
Show details. First, in steps ST2501 to ST2509 which are waveform shape parameter detecting means,
A pulse wave shape parameter A (n), which is a pulse wave attenuation characteristic, is obtained. In step ST2501, body movements and arrhythmias are removed from the n pulse wave data stored in step ST20. The maximum value of the ascending leg of the pulse wave detected in step ST2502 is stored as the peak point tp (n), and the similarly detected minimum value of the descending leg is stored as the bottom point tb (n).
In step ST2505 which is a pulse wave interval measuring means, the peak point tp (n) stored in step ST2502.
The pulse wave period (RR) is calculated from the interval and stored. For each pulse wave, a data change is searched from the pulse wave peak point tp (n) to detect and store the notch point ta (n) caused by the closing of the aortic valve of the heart. In step ST2507, a specified number of data (15 points; when sampling is 10 mS) is extracted from the data from ta (n) to the pulse wave bottom.

In step ST2508, the size of the pulse wave peak point is converted into the systolic blood pressure value (Ps) detected in step ST11, and the size of the pulse wave bottom point is converted into the diastolic blood pressure value (Pd). The data extracted in ST2507 is converted into a pressure value. Step ST25
The single exponential regression curve (Pd * E
XP (A (RR-u)) is obtained in step ST2509 to detect the pulse waveform shape parameter A (n). In detecting the pulse waveform shape parameter A (n), it is desirable to use only the pulse wave having the calculated regression curve correlation coefficient of 80 or more. In Step ST2510, the basal pulse rate RR ₀ (n) = 0.126 / A + (U ₀ / A) ^1/2 + when the basal blood pressure occurs
Calculate U ₀ . In step ST2511, the basal pulse rate RR ₀ (n) for each pulse wave is stored in the memory-11. This is repeated for the pulse wave recorded in ST20. ST2
The basal pulse rate RR _0E is calculated by taking the average of the basal pulse rate of each pulse wave calculated in 514.

Returning to FIG. 2, description will be made. Step ST26
The basal blood pressure value is calculated from the basal pulse rate obtained in. Figure 4
The detailed flowchart of the calculation of the basal blood pressure value is shown in FIG. In step ST261, a plurality of basal blood pressure data detected by another method are multivariately analyzed in the same subject as a plurality of pulse wave waveforms collected clinically to determine each constant of α and β. Set expression Diastolic blood pressure basal blood pressure Pd ₀ = Pd / EX
P (A (RR _0E −RR)) − (α * Pd / pulse rate−
(Β + Ps / pulse rate)); using α = 45 and β = 15,
The basal blood pressure of the diastolic blood pressure is calculated by substituting Pd, pulse waveform shape parameter A, RR _0E, RR, pulse rate, and Ps obtained so far.

Basal blood pressure Pd₀The first term of is the basal pulse rate and
Peripheral vascular resistance and vascular elasticity act, the second term is baroreception
This is a term related to the sensitivity of body reflex. Step ST26
Similarly, in 2, the multiple pulse wave waveforms collected clinically
Multiple basal blood detected by another method in the same subject as
By performing multivariate analysis on the pressure data, the constants of B and γ can be calculated.
The set expression is the basal blood pressure Ps of the systolic blood pressure.₀= Pd
₀* EXP (B (RR _0E-U_0E)) + Γ: B = 0.5 *
m / RR; γ = 30 was used and this formula was used to obtain
m, Pd₀, RR_0E, U_0,Substituting for systolic blood pressure
Calculate basal blood pressure. Furthermore, in step ST263
Basal blood pressure Pd of diastolic blood pressure obtained so far_0,Systole
Basal blood pressure Ps of blood pressure_0,The mean blood pressure is the basal blood pressure MB
P₀= (Ps₀-Pd₀) / 3 + Pd₀Substituting into
To calculate.

Returning to FIG. 2, white coat hypertension is detected in step ST27. FIG. 5 shows a detailed flowchart for detecting (determining) white coat hypertension. In step ST271, if the basal blood pressure MBP ₀ of the mean blood pressure is higher than 89 mmHg, it is possible that hypertension may occur, so it is determined that the white coat hypertension is not present, and the white coat hypertension display flag is left at 0 in step ST273. , 89 or less, it means that the blood pressure is normal, so that it is determined that the blood pressure is high, and the white blood pressure display flag is set to 1 in step ST272.

Returning to FIG. 2, the systolic blood pressure value and the diastolic blood pressure value are displayed on the display device 12 in step ST28, and the basal blood pressure value (systole, diastole, mean blood pressure) is displayed in step ST29. If the white coat hypertension is detected in step ST30 and the white coat hypertension display flag is 1, the indicator 1
The display of "possibility of white coat hypertension" is displayed on 2. When the white coat hypertension display flag is 0, nothing is displayed.
Then, in step ST31, the pulse rate is displayed and a series of operations is completed.

[0027]

According to the inventions described in claims 1 to 7 and 10 of the present invention, a method for wearing a sphygmomanometer using a cuff, which is the current measurement of basal blood pressure, for 24 hours is as follows: , The cuff is always attached to the arm and is restrained, and
It requires 70 to 100 regular measurements in time, and each time the arm is tightened and it is painful, and at night, sleep may be disturbed. There is a drawback in that the patient is physically and mentally burdened by the fact that the measurement is known as well as annoying.

Further, in the present situation, when a sphygmomanometer that is worn for 24 hours is used, it is necessary to block blood in the arm even at bedtime, and a problem that blood pressure becomes high due to interference with sleep due to tightening of the arm and sound of pressure pump, and Tightening of the arm, body movement due to the noise of the pressure pump occurs, and there is a drawback in measurement accuracy that an accurate blood pressure measurement is hindered by the artifact, but
According to the present invention, the basal blood pressure can be measured by a single normal blood pressure measurement, and these patient burdens are large and defects with poor accuracy can be eliminated. Further, according to the present invention, the method using a cuff, which is the current basal blood pressure measurement method, is relatively safe, but in principle, it is not possible to measure all blood pressure values of 100,000 or more times a day, and therefore the accuracy is high. The disadvantage is that is bad. On the other hand, with the method of wearing the sphygmomanometer, it is possible to measure the blood pressure 100,000 times a day, but it is necessary to insert the A line into the artery, which is very dangerous and is a well-managed medical institution. It has the drawback that it can only be done. On the other hand, according to the present invention, it is possible to realize a sphygmomanometer that can measure the basal blood pressure safely and with high accuracy.

In normal hypertensive medical care, a confirmation test in the case of suspected white coat hypertension requires waiting for the patient to settle down and measuring the blood pressure again, which requires time for medical treatment. Further, when a blood pressure monitor using a cuff is worn for 24 hours, the same problem as in the measurement of basal blood pressure occurs. In the present invention, white coat hypertension can be detected by the same single blood pressure measurement as usual, the next action can be performed immediately without waiting for the patient to settle down, and false diagnosis due to pseudo-hypertension can be prevented. Therefore, a correct diagnosis of hypertension can be speedily implemented.

According to the eighth aspect of the invention, it is possible to prevent the adverse effect on the pulse wave detection due to the temporary destabilization of the pressure system due to the decompression stop. Further, according to the invention of claim 9, by measuring in a short time,
After decompression is stopped, there is an effect of preventing deterioration of pulse wave detection quality due to an increase in compliance of the pulse wave detection system due to an increase in blood pulling amount to the cuff peripheral blood vessel and a physiological distress due to congestion. .

[Brief description of drawings]

FIG. 1 is a block diagram of an embodiment of the present invention.

FIG. 2 is an operation flow chart of the embodiment of the present invention.

FIG. 3 is a flowchart of the basal pulse rate calculating means of the embodiment of the present invention.

FIG. 4 is a flow chart for detecting white coat hypertension according to the embodiment of the present invention.
It is a chart.

FIG. 5 shows a detailed flowchart of detection (judgment) of white coat type hypertension according to the embodiment of the present invention.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Cuff for blood flow prevention, 2 ... Cuff for pulse wave detection, 5 ... Pressure sensor, 6 ... Pressurization pump, 7 ... Exhaust and constant-speed decompression valve,
10 ... MPU

Claims (10)

[Claims] 1. A cuff band and a pressurizing unit for pressurizing a fluid in the cuff band, a depressurizing unit for depressurizing the cuff band, a pressure detecting unit for detecting a fluid pressure in the cuff band, and a pulse wave at a site where the cuff band is attached. Pulse wave detecting means for detecting the blood pressure, a blood pressure determining means for determining a blood pressure value based on the fluid pressure detected by the pressure detecting means and a pulse wave detected by the pulse wave detecting means, and an expansion for determining the cuff pressure by the blood pressure determining means. It has a cuff pressure-holding means for holding a constant pressure lower than the term blood pressure, a basal pulse rate calculating means for calculating a basal pulse rate, a basal blood pressure calculating means for calculating a basal blood pressure, and a white coat hypertension determining means. A blood pressure monitor characterized by that. 2. The basal pulse rate calculating means includes an output of the pulse wave interval measuring means and an output of the pulse wave shape parameter measuring means,
2. The sphygmomanometer according to claim 1, wherein the output of the up stroke detecting means and the output of the blood pressure determining means are used. 3. The basal blood pressure value calculating means outputs the output of the basal pulse rate calculating means, the output of the waveform shape parameter detecting means, the output of the pulse wave interval measuring means, and the output of the blood pressure determining means. The sphygmomanometer according to claim 1, wherein the output of the up stroke time detecting means is used. 4. The sphygmomanometer according to claim 1, wherein the white coat hypertension judging means judges white coat hypertension by comparing an output of the basal blood pressure calculating means with a predetermined value. 5. The waveform shape parameter detecting means,
The sphygmomanometer according to claim 1 or 2, wherein an attenuation characteristic from the pulse wave peak to the bottom is detected. 6. The basal pulse rate calculating means performs multivariate analysis of a plurality of clinically collected pulse wave waveforms detected by the sphygmomanometer of the present invention and basal blood pressure data detected by another method to obtain a plurality of values. The sphygmomanometer according to claim 1, further comprising means for setting a constant. 7. The basal blood pressure value calculating means performs multivariate analysis of a plurality of pulse wave waveforms detected by the sphygmomanometer of the present invention collected clinically and basal blood pressure data detected by another method to obtain a plurality of values. The blood pressure monitor according to claim 1, further comprising means for setting a constant. 8. A predetermined time during which the pulse wave is not detected by the pulse wave detecting means when the pressure is held at a constant pressure and before the pulse wave detection is started after the pressure reduction is stopped. The blood pressure monitor according to claim 1, wherein: 9. The sphygmomanometer according to claim 1, wherein the time for holding at a constant pressure is within a predetermined second. 10. The sphygmomanometer according to claim 1, wherein the basal blood pressure values are a basal blood pressure of systolic blood pressure, a basal blood pressure of diastolic blood pressure, and a basal blood pressure of average blood pressure.